This commentary is on the invited review by Paulus et al. on pages 645–659 of this issue. The first clinical reports on patients showing an excessive and uncontrolled preoccupation with online activities were published in the 1990s. Research on this phenomenon, often called internet addiction, grew rapidly and encompassed different types of internet-based activities (e.g. gaming, social media use, online pornography, etc.). In 2013, the American Psychiatric Association included ‘Internet Gaming Disorder’ (IGD) as a preliminary diagnosis in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5).1 The World Health Organisation has now defined it as a fully recognized diagnosis in the 11th Revision of the Classification of Diseases (ICD-11).2 While these steps have generally been approved by clinicians and professionals, there have also been more cautious responses.3 The main issues concerned the nature of the diagnostic criteria for assessing IGD. Specifically, it called for a higher standard of diagnostic evidence and of conceptual transparency. One major task for the future is to consolidate the diagnostic framework for IGD with methodologically sound empirical studies. Such high-quality studies are desperately needed to evaluate the criteria's diagnostic validity in children and adolescents. It might well be that there are age-specific differences (e.g. in criteria like withdrawal or tolerance), but at present this assumption is more a vague idea than a proven fact. Yet there is almost no doubt that IGD poses a serious mental health problem. Numerous empirical studies have demonstrated significant associations between IGD and psychopathology, poorer physical health status, decreased psychosocial functioning, and lowered psychological well-being.4 Given that about 2% to 5% of adolescents are affected by IGD, this comprises a clear call for action. Other aspects of IGD remain a matter of debate, especially regarding the dynamics involved in its etiology. Following the excellent depiction by Paulus et al.,4 it is now evident that IGD should be considered as a highly complex phenomenon. A difficult interplay between variables (psychological, sociological, and neurobiological) is believed to play a crucial part in turning a mere recreational activity into a mental health issue. Unfortunately, research on risk factors has been mostly characterized by explorative approaches so far; thus, the time has come to integrate and validate these findings. We need to learn more about crucial turning points, with direct relevance for prevention and early intervention strategies. As with other behaviours that can become addictive, computer gaming is presumed to be a continuum ranging from innocuous or controlled use, to excessive and even disordered use. The identification of factors forming this transition is another key element for preventing IGD. So where do we stand right now? Clinical research has shown that IGD is now part of our reality and that the negative consequences of excessive gaming cannot be ignored. Despite all the scepticism, the DSM-5 has provided a meaningful (albeit preliminary) diagnostic framework for assessing this new clinical phenomenon. ICD-11 will also contribute a foundation from which health care professionals can face this new challenge. What is particularly needed now are more in-depth and theory-driven empirical studies to sharpen our knowledge and understanding of IGD, especially with regards to its etiology and effective treatment. The latter has been initiated, as can be seen in a current review4 and the first randomized controlled trials on the effects of psychotherapeutic interventions.5
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